As of Friday, intentions were to hold a vote on the ACA bill in the Senate this next week. This, despite the fact that Senator John McCain (R-AZ) has been diagnosed with brain cancer and will not be back next week for the vote. He would have been a supporter of the bill.
It is clear that there are at least four GOP Senators who have already gone on record saying they will oppose it. Only two opposed are required to kill it.
For a detailed review of the bill and the consensus on its ramifications, see last week’s blog post which was pretty comprehensive. Really nothing has changed since then.
Two prominent antiabortion activists who are now on staff with the Trump administration have informed 81 (EIGHTY-ONE !) teen pregnancy centers that their Federal Funding will end in 2018. How can these decisions be made without any due process whatsoever ?
On to medical news.
There is not one but two Zika vaccines under development. Zika is the dreaded virus carried by mosquitos in temperate climates which causes central nervous system and eye defects in the unborn. On of the vaccines is in human safety trials, and another is in safety trials for pregnant animals. Vaccine trials may be hampered by reduced funding to the CDC ( Centers for Disease Control) through the Trump administration.
Another approach to Zika is to introduce genetically modified strains of mosquitoes that die in one to two days. However, some on Texas object to this strategy citing possible unintended consequences.
Two to three years from now, in 2020, it is predicted that there will be a shortage of nearly 10,000 Obstetricians Gynecologists. This applies not just to rural areas, but to big cities as well. The training is hard, the hours long. The work is risky, from both a medical and a legal point of view. Costs are high if one is not employed by a large organization. Private practice Ob/Gyn is nearly extinct. Sure it can be rewarding and fascinating. It often is. Lately, though, the lack of regard for women’s health pose new concerns.
Many rural hospitals are removing maternity services. This should come as no surprise since maternity care is acute care and is potentially intensive or surgical on a reasonably regular basis. Staffing and facility needs for such care is high, and the availability of those who can render it is getting lower all the time. According to recent study, over half of rural counties in the US lack hospital based Obstetrics. In all fairness, this is a big country, unlike Europe for example, and people here sometimes choose to live way out in the boonies. It goes a long way to explaining why the US has the highest maternal mortality rate in the developed world. That, together with the obesity epidemic, its complications of diabetes, hypertension and preeclampsia, and the defunding of women’s health care resources explain it well enough.
How bad is the obesity epidemic ? Perhaps you have no objections to a full figure. Ok, but do you object to life shortening disease ? Of course. The CDC now reports that over 100 million US citizens have diabetes or pre diabetes. Most with pre diabetes do not even realize they have it. If you are overweight, ask your caregiver to screen you with fasting blood sugar, 2 hour blood sugar after eating, and also screen your cholesterol and triglycerides ! Knowledge is power.
Fake sweeteners are not helpful. A new meta analysis of 7 studies has shown that people consuming these do not lose weigh compared to those who do not consume them. Moreover, these studies also show that those consuming artificial sweeteners are at increased risk for obesity, diabetes, and cardiovascular issues over time compared to non-users. This probably has more to do with the misbegotten habits of the users rather than something intrinsic to the artificial sweeteners, but we simply do not know.
We always need some news in the-we-already-knew-this department. This week, we again learned that healthy diet and exercise in pregnancy are associated with lower rates of gestational diabetes and C section.
Finally, in very interesting and early work, thyroid hormone and metformin (a common diabetic medication) seem to be able to reduce memory and learning problems in rats exposed to alcohol during pregnancy. This groundbreaking work was published in Molecular Cytology and will hopefully spur more research on the subject.
Stay tuned for more exciting news next week, on Medical Monday.